Immanuel House Personal Care Home, LLC

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

Legal business name

IMMANUEL HOUSE PERSONAL CARE HOME, LLC

Practice address

422 N Washington Street
Mount Vernon, GA 30445

Phone

(740) 600-0004

NPI assigned

Jul 7, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Wiggs, LPN

Title

Director

Phone

(740) 600-0004

Specialties & licenses 1

Addresses

Other names 1

• Immanuel House Personal Care Home, LLC Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1205514445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 TEATSWORTH DR",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456012752",
            "telephone_number": "740-600-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 N WASHINGTON STREET",
            "city": "MOUNT VERNON",
            "state": "GA",
            "postal_code": "30445",
            "telephone_number": "740-600-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL HOUSE PERSONAL CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "WIGGS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "740-600-0004",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immanuel House Personal Care Home, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Licensed Practical Nurse in Mount Vernon, GA
• Providers in Mount Vernon, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.